This issue started with the DREAM study presented in 42nd EASD meeting in Copenhagen in 2006 which included 5000 pts with prediabetes (& no CVS disease) ,showed a 62% reduction in incidence of diabetes over 3 yrs compared to placebo. But a letter to editor from Dr.Nissen brought out that rosiglitazone resulted in a 37% increase in adverse cardiovascular events, a finding that very nearly reached conventional levels of significance.

on May 21, 2007, the US Food and Drug Administration (FDA) published a “safety alert”, concluding that “serious concern” existed over GSK's rosiglitazone.

Subsequently two metaanlysis done on same topic ( Nissen et al in 2007, and FDA analysis in 2007 ) revealed a 30-40% greater risk of MI and a borderline-significant increased risk of death from cardiovascular causes. Many other studies showed nearly same risk with Rosiglitazone.So,on July 14,2010 FDA advisory comittee voted on this. It was a 20 - 12 to keep the drug on market, but with strong warnings.

Both of them activate peroxisome proliferator-activated receptor (PPAR)α. But Pio acts on a different ligand than rosi, and thats probably why,the difference in their action.So for now, if we have to choose a TZD ,Pioglitazone seems a better option. Any questions?!

Page Counter

DISCLAIMER

This is a blog created by Suresh Samson for the purpose of creating a learning and teaching environment for Internal Medicine residents, fellows, and other healthcare professionals. Information provided here is for medical education only.It contains opinions and thoughts, and links to other sources of information.All opinions expressed here are those of their authors and not their employer.Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website. The appearance of external hyperlinks to other websites does not constitute endorsement. We do not verify, endorse, or take responsibility for the accuracy, currency, completeness or quality of the content contained in these sites.All case descriptions are fictional, similar or altered to protect patient information to the descriptions you can find in a multiple choice questions textbook for board exam preparation.For any important health or medical issues - you should be talking to your doctor - not taking the advice of an on-line blog.Any information listed on this site is for our own education and the education of others. It is not intended to diagnose, prevent, treat, or cure any disease